Provider Demographics
NPI:1467280024
Name:EL SHADDAI HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:EL SHADDAI HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOGBEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:757-735-6038
Mailing Address - Street 1:82 JEROME RD
Mailing Address - Street 2:APT 226
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2342
Mailing Address - Country:US
Mailing Address - Phone:757-735-6038
Mailing Address - Fax:
Practice Address - Street 1:82 JEROME RD
Practice Address - Street 2:APT 226
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2342
Practice Address - Country:US
Practice Address - Phone:757-735-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health